Acute Otitis Media – September 19, 2024
A 4-year-old child presented to the Pediatric emergency department (ED) with a complaint of ear pain. Her mother reported her daughter had a few days of nasal congestion and complained of pain in the right ear the previous day. She did not seek care since there was no fever and the pain resolved with ibuprofen. However, shortly after going to bed, she awoke crying due to ear pain. This time, the ibuprofen did not seem to help, so she was brought in for evaluation. In the ED, the child is febrile to 102oF. She appears uncomfortable and hesitant to allow an ear exam. With gentle coaxing, the Wispr digital otoscope exam was obtained and is shown. Her medical history is unremarkable, she has no known drug allergies and has had only one ear infection in the past. Mom did not recall how long ago, but it resolved with “the pink medicine.”
What is the appropriate management for this child?
- Ibuprofen and just-in-case prescription of antibiotics
- Treat immediately with amoxicillin and consider topical anesthetic
- Treat immediately with Augmentin
- Treat immediately with azithromycin
Answer: B. Treat immediately with amoxicillin and consider topical anesthetic
The child in this case has right acute otitis media (AOM) as evidenced by moderate bulging of the tympanic membrane (TM ). The TM is impressively injected centrally over the umbo and has a cloudy middle ear effusion (MEE). There is also a rim of cloudy MEE suggesting an evolving AOM. Since she has not received antibiotics in the previous 30 days, first-line therapy is high dose amoxicillin (40-45mg/kg twice daily). Given her level of pain has not improved with ibuprofen, treatment with a topical anesthetic such as proparacaine drops may be considered for more immediate relief of symptoms.
WiscMed has created a visual guide to ear diagnosis that can be found here.
Here is the complete video exam.
Reference:
Allan S. Lieberthal, Aaron E. Carroll, Tasnee Chonmaitree, Theodore G. Ganiats, Alejandro Hoberman, Mary Anne Jackson, Mark D. Joffe, Donald T. Miller, Richard M. Rosenfeld, Xavier D. Sevilla, Richard H. Schwartz, Pauline A. Thomas, David E. Tunkel; The Diagnosis and Management of Acute Otitis Media. Pediatrics March 2013; 131 (3): e964–e999. 10.1542/peds.2012-3488
